Posted: May 24th, 2022

Cryptorchidism Acute Scrotum Essay


Acute Scrotum Case Study

Don't use plagiarized sources. Get Your Custom Essay on
Cryptorchidism Acute Scrotum Essay
Just from $13/Page
Order Essay

When a male presents with acute scrotum pain and swelling a number of different diagnoses are possible; however, if the diagnosis is testicular torsion then the patient needs to be evaluated by a competent surgeon immediately (reviewed by Kass and Lundack, 1997). Of the many possible diagnoses that can produce similar symptoms, including epididymitis, hernia/hydrocele, varicocele, epididymo-orchitis, torsion of a testicular or epididymal appendage (appendiceal torsion), or Henoch-Schonlein purpura, only testicular torsion represents a bona fide medical emergency. For this reason, a detailed patient history and physical examination should be undertaken at once in order to preserve testicular function. Every effort should be made to gather a complete urologic and surgical history for the patient to exclude other conditions, including a urinary tract infection and epididymitis.

A recent study examined the diagnosis distribution for 388 boys under the age of 17 who were treated at the Hospital for Children and Adolescents in Helsinki between 1977 and 1995 for acute scrotum (Makela, Lahdes-Vasama, Rajakorpi, and Wikstrom, 2007). Testicular torsion occurred in 26% of cases, while appendiceal torsion, epididymitis, and hernia occurred in 45%, 10%, and 8% of cases, respectively. The peak ages for testicular torsion occurred during the first year of life and adolescence (13 to 16 years). By comparison, the peak age for appendiceal torsion was between 9 and 12 years of age. Epididymitis preferentially occurred in infants under one year of age and was only rarely found on older boys and adolescents.

The case study considered here describes a 15-year-old boy presenting with a painful and red hemiscrotum containing a swollen descended testicle. Based on the findings of the Helsinki study (Makela, Lahdes-Vasama, Rajakorpi, and Wikstrom, 2007) the most likely diagnosis is testicular torsion given the boy’s age, although he could still be suffering from several other conditions. The age of 15 is well within the adolescent peak range of 13 to 16 years for males diagnosed with testicular torsion. Scrotal pain, testicular oedema, and scrotal erythema were found in patients with testicular torsion (68%, 44%, 16%), appendiceal torsion (94%, 39%, 32%), and epididymitis (58%, 50%, 37%).

The patient is also nauseated and running a temperature of 101 F. Based on the Helsinki study (Makela, Lahdes-Vasama, Rajakorpi, and Wikstrom, 2007) 5%, 2%, and 3% of patients with testicular torsion, appendiceal torsion, or epididymitis experience nausea or vomiting, respectively, so this was a rare symptom. Febrile patients were also rare in the first two conditions, but slightly more common in epididymitis (16%). Urine cultures were found to be positive in 26% of patients with epididymitis, but all of these patients were under one year of age. Statistically, the most likely diagnosis for the patient considered here is testicular torsion; however, the other possibilities cannot be ruled out.

Sudden onset of pain is more characteristic of testicular torsion than appendiceal torsion or epididymitis, whereas the onset of pain for the latter two conditions tends to occur more gradually (Kass and Lundack, 1997). If the patient is rushed to the hospital immediately or within a few hours of pain onset, this would be consistent with a diagnosis of testicular torsion. The severity of the pain can also be assessed by observing whether the patient is preoccupied by the pain or easily engaged in conversation with family and friends. The cremasteric reflex should be examined by stroking or gently pinching the medial thigh, but this should be done with the unaffected side first to establish a baseline. An absent cremasteric reflex for the affected testicle is a strong, but not absolute indication of testicular torsion (Nelson, Williams, and Bloom, 2003). In cases of testicular torsion the testicle is already retracted to an upper position and therefore no movement of the testicle occurs. The patient being considered here does not have a cremasteric reflex and the most likely diagnosis is testicular torsion; however, as boys grow older (> 12 years of age) the cremasteric reflex is less prevalent.

The length of time that the symptoms have been present can help with the evaluation (Kass and Lundack, 1997). By 24 hours there is little difference between testicular torsion, appendiceal torsion, and epididymitis, but cases with recent symptom onset can reveal subtle differences. A testicle positioned high in the scrotum and to one side (transverse) is more consistent with testicular torsion. Upon palpation of testicles with recent acute onset, palpation will reveal a swollen testicle if the patient is suffering from testicular torsion. Tenderness will be more diffuse for testicular torsion, but limited to the upper pole in cases of appendiceal torsion. If the epididymis is tender in the absence of testicular tenderness then epididymitis is probable. Given that the patient in this case study has a swollen descended testicle the most consistent diagnosis is testicular torsion.

The only laboratory test that should be run is a urinalysis to check for a urinary tract infection (Kass and Lundack, 1997). A positive result showing pus and/or the presence of bacteria would be consistent with epididymitis. The preferred method of imaging is pulsed color Doppler ultrasonography, which can reveal differences in intratesticular anatomy and testicular blood velocity. Reduced or absent blood flow compared to the unaffected testis is diagnostic of testicular torsion, while increase blood flow would be consistent with epididymitis. If adequate imaging resources are not immediately available, exploratory surgery should be undertaken immediately. Time is of the essence, since the testicle should be detorsed within 6 hours of symptom onset to increase the chance of rescuing the testicle (Makela, Lahdes-Vasama, Rajakorpi, and Wikstrom, 2007). The Helsinki study revealed a 100% rescue rate if surgery was performed within 6 hours of onset. The rescue rate decreased to 50% between 6 and 12 hours and to 4% between 12 and 24 hours.

Given the age of onset for the patient under consideration here, the scrotal pain and redness, the testicular swelling, and an absent cremasteric reflex, the most likely diagnosis is testicular torsion. Surgery should be performed immediately to detorse the affected testicle or to exclude this diagnosis (Kass and Lundack, 1997). The goals of the surgery should be to detorse the testicle if it can be rescued and to correct the anatomic deformity (orchiopexy) that causes testicular torsion. Testicular torsion can occur during the perinatal period because the testis have not yet fixated within the tunica vaginalis, but in a boy of 15 years testicular torsion is caused by the “bell clapper” deformity and the testicles will need to be sutured to permanently fix them within the scrotum. Once the affected testicle has been rescued then a decision can be made about performing an orchiopexy to correct the anatomic deformity that likely exists in the contralateral side.


One of the earliest indicators of testicular torsion is the sudden onset of severe pain that results in a quick trip to the emergency room. When a boy of 15 years presents with hemiscrotal pain, swelling, and redness the most likely diagnoses are testicular torsion, appendiceal torsion, or epididymitis. The febrile state of the patient could indicate epididymitis, but the absent cremasteric reflex and swollen testicle is most consistent with testicular torsion. Although ultrasound or radionuclide imaging could be informative, the absent reflex and swollen testicle is sufficient justification to surgically explore the affected testicle (Ringdahl and Teague, 2006). If surgery reveals a torsed testicle then it should be detorsed and orchiopexy performed. Given the age of the patient it is very likely that the unaffected testicle suffers from the same anatomic deformity that causes testicular torsion. Orchiopexy should therefore be performed sometime in the future for this side as well.


Kass, Evan J. And Lundak, Bruce. (1997). The acute scrotum. Pediatric Clinics of North America, 44(5), 1251-1266.

Makela, E., Lahdes-Vasama, T., Rajakorpi, H., and Wikstrom, S. (2007). A 19-year review of paediatric patients with acute scrotum. Scandinavian Journal of Surgery, 96, 62-66.

Nelson, Caleb P., Williams, JeffreyF., and Bloom, David A. (2003). The cremasteric reflex: A useful but imperfect sign in testicular torsion. Journal of Pediatric Surgery, 38, 1248-1249.

Ringdahl, Erika and Teague, Lynn. (2006). Testicular torsion. American Family Physician, 74, 1739-1743.

Get Professional Assignment Help Cheaply

Buy Custom Essay

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

  • Plagiarism free papers
  • Timely delivery
  • Any deadline
  • Skilled, Experienced Native English Writers
  • Subject-relevant academic writer
  • Adherence to paper instructions
  • Ability to tackle bulk assignments
  • Reasonable prices
  • 24/7 Customer Support
  • Get superb grades consistently

Online Academic Help With Different Subjects


Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.


Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!


While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.


Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.


In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.


Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.


We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!


We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.


Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment  Help Service Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

smile and order essaysmile and order essay PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!

order custom essay paper

Expert paper writers are just a few clicks away

Place an order in 3 easy steps. Takes less than 5 mins.

Calculate the price of your order

You will get a personal manager and a discount.
We'll send you the first draft for approval by at
Total price:
Open chat
Need assignment help? You can contact our live agent via WhatsApp using +1 718 717 2861

Feel free to ask questions, clarifications, or discounts available when placing an order.